Redo ileal pouch‐anal anastomosis: outcomes from a case–controlled study

Abstract

Aim To assess short‐ and long‐term outcomes of redo ileal pouch‐anal anastomosis (redo‐IPAA) for failed IPAA, comparing them with those of successful IPAA. Method This was a case–control study. Data were collected retrospectively from prospectively maintained databases from two tertiary care centres. Patients who had a redo‐IPAA between 1999 and 2016 were identified and matched (1:2) with patients who had a primary IPAA (p‐IPAA), according to diagnosis, age and body mass index. Results Thirty‐nine redo‐IPAAs (16 transanal and 23 abdominal procedures) were identified, and were matched with 78 p‐IPAAs. After a mean follow‐up of 56 ± 51 (2.6–190) months, failure rates after transanal and abdominal approaches were 50% and 15%, respectively. Reoperation after the transanal approach was higher than after p‐IPAA (69% vs 7%; P < 0.001). No differences were noted between the abdominal approach for redo‐IPAA and p‐IPAA in terms of morbidity (61% for redo‐IPAA vs 38% for p‐IPAA; P = 0.06), major morbidity (9% vs 8%; P = 0.96), anastomotic leakage (13% vs 10%; P = 0.74), mean daily bowel movements (6 vs 5.5; P = 0.68), night‐time bowel movements (1.2 vs 1; P = 0.51), faecal incontinence (13% vs 7%; P = 0.40), urgency (31% vs 27%; P = 0.59), use of anti‐diarrhoeal drugs (47% vs 37%; P = 0.70), mean Cleveland Global Quality‐of‐Life score (7 vs 7; P = 0.83) or sexual function. Conclusion The abdominal approach for redo‐IPAA is justified in cases of pouch failure because it achieves functional results comparable with those observed after p‐IPAA, without higher postoperative morbidity. The transanal approach should be chosen sparingly.

Third Time’s the Charm? Indications and Outcomes for Redo-Redo IPAA

“…Redo IPAA is associated with worse functional outcomes relative to the index IPAA, as well as a higher risk of failure than the index IPAA, which develops in 20% to 40% of cases. [6][7][8] The treatment of redo IPAA failure is permanent ileostomy with or without pouch excision for the vast majority of patients. The decision to offer a second redo procedure to maintain intestinal continuity is controversial, and scarce evidence exists regarding long-term pouch survival and functional outcomes after redo-redo IPAA.…”

“…Redo IPAA is associated with worse functional outcomes relative to the index IPAA, as well as a higher risk of failure than the index IPAA, which develops in 20% to 40% of cases. 6–8…”

Redo ileal pouch‐anal anastomosis: outcomes from a case–controlled study by Rossi et al.

“…Rossi et al . have put together a matched series of redo pouches as compared to primary pouch construction with regard to both short term morbidity and longer term functional results. Pouch revision or reconstruction is an important topic to highlight as up to 3–15% of pouches will fail, largely due to pelvic sepsis following the initial pouch construction.…”